Provider Demographics
NPI:1003959453
Name:BAZE, CARL RANDOLPH (DC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:RANDOLPH
Last Name:BAZE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SW 41ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-251-5715
Mailing Address - Fax:425-251-0703
Practice Address - Street 1:200 SW 41ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-251-5715
Practice Address - Fax:425-251-0703
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000100353Medicare ID - Type Unspecified